CBO: 22 million more uninsured under Senate health bill

The Senate Republican health care bill would leave 22 million more Americans uninsured over a decade, according to a Congressional Budget Office projection that could complicate the party’s push to hold a vote on the plan this week.

The estimated coverage losses are just slightly less than for the House-passed version of the Obamacare repeal bill, which concern Republican moderates who have pushed Senate leaders to craft a more generous bill.

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"It makes me more concerned," Sen. Bill Cassidy of Louisiana said of the CBO score during an appearance on CNN. "I've been uncommitted and I remain uncommitted."

The Senate legislation also would cut the federal deficit by $321 billion over 10 years, driven by deep cuts to Medicaid and skimpier aid for people purchasing private coverage. Those savings far exceed the $119 billion target set by the House bill, meeting a key requirement for Republicans hoping to pass the Senate bill through a fast-track budget process needing just 51 votes.

That would also give Republican leaders much-needed flexibility to add financial sweeteners aimed at winning over skeptical GOP senators, including those worried that the bill would too deeply cut Medicaid or set back efforts to combat the nationwide opioid epidemic. But additional spending could further alienate the chamber’s conservatives, who are pushing for a more aggressive rollback of President Barack Obama’s signature health care law.

With Democrats solidly lined up against the repeal bill, Republican leaders can afford to lose support from only two of their members. But five GOP senators have pledged to vote against the current draft of the bill since it was released Thursday, and several more are undecided.

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Republican leaders, meanwhile, remain committed to holding a vote on their bill dismantling Obamacare in the days ahead of the July 4 recess. After suggesting over the weekend that the vote could be pushed off several weeks, Senate Majority Whip John Cornyn said Monday that Republicans “need” to pass the bill this week and could take their first procedural vote toward repeal as early as Tuesday.

The CBO score could make that already tight timeline even more difficult to hit without another round of changes to the bill. The CBO projected the earlier House-passed repeal plan would leave 23 million more uninsured, fueling backlash to a bill that President Donald Trump called “mean” after weeks of criticism. Yet, the Senate’s plan is now projected to leave nearly the same number without coverage.

"As more and more people continue to lose coverage and face fewer healthcare choices, President Trump is committed to repealing and replacing Obamacare, which has failed the American people for far too long," the White House said in a statement.

Sen. Susan Collins (R-Maine), a moderate swing vote, said last week she can’t support a bill that would cost “tens of millions” of people their health care. Nevada Sen. Dean Heller, the most vulnerable GOP incumbent up for reelection next year, condemned the Senate plan in harsh terms last week but didn't rule out voting for a version with more Medicaid funding.

Other critics, including Sen. Ron Johnson (R-Wis.), have demanded more time to evaluate the bill’s impact and negotiate more changes. Any revisions to the Senate bill would need to be rescored by the CBO before it could advance to a vote.

Under reconciliation — the budget maneuver Republicans are using to try to push through Obamacare repeal without any Democratic votes — the Senate legislation must save at least as much money as the House version does. The House bill would produce $119 billion in savings, giving Majority Leader Mitch McConnell more than $200 billion to make the bill’s coverage more robust should he choose to court reluctant Republican moderates.

Any changes to the bill, however, are unlikely to radically alter CBO’s projection that millions more would go uninsured compared with Obamacare. The agency said that 15 million people would be newly uninsured as the result of phasing out generous federal funding for Obamacare’s Medicaid expansion and capping the entire program’s funding for the first time.

About 7 million fewer people would buy their own insurance in the individual market, the CBO projected. Overall, the bill provides less generous financial support to purchase private coverage compared with Obamacare, and patients would cover more out-of-pocket expenses. In particular, the uninsured rate among older, low-income Americans would spike as the result of much higher premiums.

Some of those keeping coverage could end up with health plans that are near-unusable. For example, CBO projects that plans designed for the poorest enrollees could come with deductibles equal to half their annual income. And in states that opt to waive additional Obamacare protections under the bill, insurers could be allowed to reinstate annual and lifetime caps on certain benefits.

“This bill is every bit as mean as the House bill,” Senate Minority Leader Chuck Schumer said Monday evening. “This CBO report should be end of the road for Trumpcare."

Customers in the individual market would initially see sharp premium increases until 2020, after which premiums would drop as states get more leeway to slash Obamacare’s coverage requirements. CBO projected that average premiums for the benchmark plan — a key marker for determining federal tax credits — would fall 30 percent in 2020 compared with Obamacare, as insurers roll back benefits and receive a boost from federal funding meant to stabilize the shaky market. Republicans, who have made cheaper premiums a main goal for their health care legislation, are likely to point to this finding as evidence that their bill is an improvement over Obamacare.

Republicans also argue that more people might choose to stop purchasing health insurance without the threat of Obamacare’s penalty for going uninsured, which this bill eliminates. Instead, an updated version of the Senate bill includes a provision that would lock people out of coverage for six months if they were previously uninsured. That is meant to discourage people from waiting until they are sick to purchase health insurance.